Practice team blog

It was when I was editing one of this week’s articles on stroke that I was struck by the reference to interdisciplinary working and how it was benefiting patients.

When discussing early mobilisation and positioning in stroke the authors identify how the patients need 24 hours care, particularly in certain aspects of care to make the best recovery.

They point out that if nurses learn safe and correct ways to move and handle individual patients, it means the patients are not waiting for the physiotherapist to move them.

The skills would come from training but also from working with the

with the unit-based physiotherapist. This is where interdisciplinary skills come in so that the different professions are working together rather than side by side.

Nurses are with patients 24/7 so the benefit to the patient is huge meaning that their mobilisation can continue at weekends and out of hours. The patients’s outcomes will be better and also their engagement with the project of recovery will not be frustrated, for example by them waiting for the physiotherapist.

In recent years there has been a lot of discussion about the changing role of the nurse, and the blurring of boundaries between medicine and nursing. Yet patients also benefit significantly from interprofessional learning and sharing skills with other members of the healthcare team.

In many universities interprofessional learning is common practice with OT, medical, nursing and physiotherapy students learning together and sharing knowledge and skills. But this should not be confined to under graduate programmes. We need to move to develop true interprofessional practice to ensure holistic care for all patients

Upskilling nurses with crossover skills from the other disciplines will be good for the patients and for the profession. It’s not a case of doing someone else job as, for example in moving and handling patients, it is part of nurses’ job. It’s a case of refining and developing those skills in partnership with other professions to benefit patients.

Multidsciplinary was the new buzz word about 20 or more years ago. Perhaps it’s time to move things onto interdisciplinary.

For 35 years my mother lived with bipolar disorder. It is difficult to imagine what it must have been like for her not to sleep for days on end and at other times just sit and cry and cry and cry. It was hard enough watching it.

Over 35 years my family got used to a pattern of care; crisis, hospital admission, medication, non-adherence, crisis. Mum had numerous hospital admissions, ECT and plenty of medication but very little interaction with health professionals.

Support in the community was hit and miss. CPNs were our lifeline, but as Mum did not always co-operate and on several occasions she was often signed off CPN caseloads because she did not appear to benefit from the visits. This meant that when a crisis happened we had no direct access into mental health services, resulting in delays in treatment and sectioning under the Mental Health Act, which could have been avoided with early intervention.

So why am I telling you this? Well a report published last week by the The Schizophrenia Commission describes care for people with schizophrenia and psychosis as falling “catastrophically short” . It highlights the value of preventative work in the community, which can do so much to improve patients’ quality of life.

The long-term consequences on Mum’s physical health only became apparent in later life. We found GPs, hospital consultants and general nurses had very little understanding of the complex relationship between her mental and physical health problems. It is easy to overlook physical problems when you are dealing with someone who has an understandably deep-seated suspicion of doctors and is reluctant to communicate with them.

I am not an expert, but it seems to me that the sensible ideas in the report could apply to many other mental health conditions. For 35 years my Mum was cared for in underfunded services, in generally poor conditions, where staff were often forced to ration care to those most in need. What this means is people like my Mum got her anti psychotics and mood stabilisers but very little else. I think she deserved better – as do people in her situation today.

I know there is excellent practice going on and we regularly publish examples of innovations that make a difference in mental health. It is vital that this practice is shared so if you are doing great work please tell me about it!

One of the worst examples in recent history was the hysteria whipped up about the MMR jab, on the basis of highly questionable evidence from a tiny sample of children. This evidence has now been utterly discredited, but not before vaccination rates dropped to dangerous levels.

The latest target is the Liverpool Care Pathway, or the pathway to death as the Daily Mail prefers. A torrent of stories about hospitals being bribed to put patients on the LCP, patients being routinely denied food and fluids, or health professionals being too keen put patients on the pathway and refusing to take them off if they show signs of recovery have bounced health secretary Jeremy Hunt into declaring that the revised NHS Constitution will require patients and or families to be involved in end-of-life care decisions.

Anyone who took the time to read less sensationalist sources – or to look at the LCP documentation itself – would see that the pathway is simply a tool to help health professionals to make the last hours of their patients’ lives as peaceful as possible. It is only to be used in patients who are dying, and any who show signs of recovery can be taken off the pathway. Food and fluids are only withdrawn in specific circumstances where this will reduce patient distress, and patients and families are already required to be involved in the decision-making process.

Of course, like any tool, the LCP is only as good as the people who use it, so it is vital that it is implemented by health professionals who understand its principles and purpose, and who stick to the guidance.

Properly used the LCP is a way of providing the best possible care to dying patients and their families. Attacks on the pathway on the basis of instances of improper us, or presenting opinions as facts will simply lead patients, professionals and families to avoid using a tool that has spared countless people distress in their final hours.

A recent US study has revealed that overnight noise levels in intensive care units often exceed levels recommended by the World Health Organization. The assumptions seems to be that if patients are asleep, sedated and even unconscious they won’t be affected by the beeping and noises of machines.

However the researchers concluded that sleep disruption was prevalent and could impact on levels of delirium and negatively impact on immune dysfunction, as well as potentially adversely affect outcomes.

It can seem old fashioned in this world of high-tech health care to remember how important rest and sleep are to recovery. Sometimes malfunctioning equipment keeps beeping and being reset without anyone thinking of how it is affecting the patients. And when working at night, it is too easy to forget that others need to rest when the night has become your day.

We all know what it is like to be woken up by a car or house alarm at night and how this affects your performance the next day, giving us some insight into how patients feel about the constant beeping and alarms on hospital wards.